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High Altitude Edema

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121. Rhodiola crenulata Extract Alleviates Hypoxic Pulmonary Edema in Rats. Full Text available with Trip Pro

Rhodiola crenulata Extract Alleviates Hypoxic Pulmonary Edema in Rats. Sudden exposure of nonacclimatized individuals to high altitude can easily lead to high altitude illnesses. High altitude pulmonary edema (HAPE) is the most lethal form of high altitude illness. The present study was designed to investigate the ability of Rhodiola crenulata extract (RCE), an herbal medicine traditionally used as an antiacute mountain sickness remedy, to attenuate hypoxia-induced pulmonary injury. Exposure (...) of animals to hypobaric hypoxia led to a significant increase in pathological indicators for pulmonary edema, including the lung water content, disruption of the alveolar-capillary barrier, and protein-rich fluid in the lungs. In addition, hypobaric hypoxia also increased oxidative stress markers, including (ROS) production, (MDA) level, and (MPO) activity. Furthermore, overexpression of plasma (ET-1), (VEGF) in (BALF), and (HIF-1 α ) in lung tissue was also found. However, pretreatment with RCE relieved

2013 Evidence-based Complementary and Alternative Medicine (eCAM)

122. High-Field MRI Reveals a Drastic Increase of Hypoxia-Induced Microhemorrhages upon Tissue Reoxygenation in the Mouse Brain with Strong Predominance in the Olfactory Bulb Full Text available with Trip Pro

to normobaric hypoxia at 8% oxygen for 48 hours followed by rapid reoxygenation and incubation for further 24 h under normoxic conditions. T2*-, diffusion-weighted and T2-relaxometry MRI was performed before exposure, immediately after 48 hours of hypoxia and 24 hours after reoxygenation. Cerebral microhemorrhages, previously described in humans suffering from severe high altitude cerebral edema, were also detected in mice upon hypoxia-reoxygenation with a strong region-specific clustering in the olfactory (...) High-Field MRI Reveals a Drastic Increase of Hypoxia-Induced Microhemorrhages upon Tissue Reoxygenation in the Mouse Brain with Strong Predominance in the Olfactory Bulb Human pathophysiology of high altitude hypoxic brain injury is not well understood and research on the underlying mechanisms is hampered by the lack of well-characterized animal models. In this study, we explored the evolution of brain injury by magnetic resonance imaging (MRI) and histological methods in mice exposed

2016 PloS one


HIGH-ALTITUDE RETINOPATHY AFTER CLIMBING MOUNT ACONCAGUA IN A GROUP OF EXPERIENCED CLIMBERS. Visual disturbances after high-altitude exposure were first reported in 1969. Manifestations may include retinal hemorrhage, papilledema, and vitreous hemorrhage.We observed a group of 6 experienced climbers who ascended Mt Aconcagua to an altitude of 6,962 m in February 2007. Visual acuity study, intraocular pressure study, visual field study, nerve fiber layer analysis, eye Doppler, laboratory studies (...) , fundus photography, and intravenous fluorescein angiography were performed on the climbers before and after their exposures to high altitude.In all six study subjects, retinal vascular engorgement and tortuosity were present in varying degrees in both eyes. One of the climbers had both retinal hemorrhage and pulmonary edema. Of the two subjects who had visual field defects, one had severe nerve fiber layer defects of both eyes. Furthermore, laboratory studies of this climber showed a high level

2011 Retina

124. Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. (Abstract)

. They were then monitored up at high altitude and classified as suffering from severe high-altitude illness (SHAI) or not. Analysis was stratified according to acetazolamide use.Severe acute mountain sickness occurred in 314 (23.7%), high-altitude pulmonary edema in 22 (1.7%), and high-altitude cerebral edema in 13 (0.98%) patients. Among nonacetazolamide users (n = 917), main factors independently associated with SHAI were previous history of SHAI (adjusted odds ratios [aOR], 12.82; 95% confidence (...) Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. An increasing number of persons, exposed to high altitude for leisure, sport, or work, may suffer from severe high-altitude illness.To assess, in a large cohort of subjects, the association between physiological parameters and the risk of altitude illness and their discrimination ability in a risk prediction model.A total of 1,326 persons went through a hypoxic exercise test before a sojourn above 4,000 m

2011 American Journal of Respiratory and Critical Care Medicine

125. Sea-Level Assessment of Dynamic Cerebral Autoregulation Predicts Susceptibility to Acute Mountain Sickness at High Altitude. Full Text available with Trip Pro

=0.001 and Environmental Symptoms Cerebral Symptoms: +0.6±0.9 points, P=0.0003 versus sea level). Inverse relationships were observed between the sea-level autoregulation index score and the high-altitude-induced increases in the Lake Louise (r=-0.62, P=0.007) and Environmental Symptoms Cerebral Symptoms (r=-0.78, P=0.01) scores. One subject with a history of high-altitude pulmonary and cerebral edema presented with the lowest sea-level autoregulation index score (3.7 versus group: 6.2±1.0 points (...) ) and later developed high-altitude cerebral edema at 4800 m during the summit bid.These findings suggest that a lower baseline autoregulation index may be considered a potential risk factor for AMS. This laboratory measurement may prove a useful screening tool for the expedition doctor when considering targeted pharmacological prophylaxis in individuals deemed "AMS-susceptible."

2011 Stroke

126. Reducing Pulmonary Injury by Hyperbaric Oxygen Preconditioning During Simulated High Altitude Exposure in Rats. (Abstract)

Reducing Pulmonary Injury by Hyperbaric Oxygen Preconditioning During Simulated High Altitude Exposure in Rats. Hyperbaric oxygen preconditioning (HBO₂P + HAE) has been found to be beneficial in preventing the occurrence of ischemic damage to brain, spinal cord, heart, and liver in several disease models. In addition, pulmonary inflammation and edema are associated with a marked reduction in the expression levels of both aquaporin (AQP) 1 and AQP5 in the lung. Here, the aims of this study (...) are first to ascertain whether acute lung injury can be induced by simulated high altitude in rats and second to assess whether HBO2P + HAE is able to prevent the occurrence of the proposed high altitude-induced ALI.Rats were randomly divided into the following three groups: the normobaric air (NBA; 21% O₂ at 1 ATA) group, the HBO₂P + high altitude exposure (HAE) group, and the NBA + HAE group. In HBO₂P + HAE group, animals received 100% O₂ at 2.0 ATA for 1 hour per day, for five consecutive days

2011 Journal of Trauma

127. Sildenafil citrate for the prevention of high altitude hypoxic pulmonary hypertension: double blind, randomized, placebo-controlled trial. (Abstract)

Sildenafil citrate for the prevention of high altitude hypoxic pulmonary hypertension: double blind, randomized, placebo-controlled trial. Exaggerated hypoxic pulmonary vasoconstriction is a key factor in the development of high altitude pulmonary edema (HAPE). Due to its effectiveness as a pulmonary vasodilator, sildenafil has been proposed as a prophylactic agent against HAPE. By conducting a parallel-group double blind, randomized, placebo-controlled trial, we investigated the effect (...) of chronic sildenafil administration on pulmonary artery systolic pressure (PASP) and symptoms of acute mountain sickness (AMS) during acclimatization to high altitude. Sixty-two healthy lowland volunteers (36 male; median age 21 years, range 18 to 31) on the Apex 2 research expedition were flown to La Paz, Bolivia (3650 m), and after 4-5 days acclimatization ascended over 90 min to 5200 m. The treatment group (n=20) received 50 mg sildenafil citrate three times daily. PASP was recorded

2011 High altitude medicine & biology Controlled trial quality: predicted high

128. Change in Peripheral Oxygen Saturation by Using Different Breathing Procedures in High Altitude

: University of Giessen Collaborator: MVZ für Laboratoriumsmedizin Koblenz Information provided by (Responsible Party): Andree Hillebrecht, University of Giessen Study Details Study Description Go to Brief Summary: In this investigation the researchers explore whether different types of breathing procedures can improve the peripheral oxygen saturation to reduce the risk of becoming a acute mountain sickness or a high altitude pulmonary edema. Condition or disease Intervention/treatment Phase Acute Mountain (...) in pressure and lowering partial pressure of oxygen during increasing altitude. The direct consequence of those changes is a hypoxic pulmonary vasoconstriction (Euler-Lijestrand-mechanism). In addition a rise in pulmonary blood pressure (Hypertonia) can occur so that there is a higher risk of developing a high altitude pulmonary edema (HAPE). In this investigation the investigators are exploring whether different types of breathing procedures can improve the peripheral oxygen saturation. We are comparing

2011 Clinical Trials

129. Altitude Diseases

manifestations; it may occur in recreational hikers and skiers and others traveling to high altitude. High-altitude cerebral edema (HACE) is a form of global encephalopathy, while high-altitude pulmonary edema (HAPE) is a form of noncardiogenic pulmonary edema causing severe dyspnea and hypoxemia. Diagnosis of AD is clinical. Treatment of mild AMS is with analgesics and acetazolamide or dexamethasone . Severe AMS may require descent and supplemental oxygen if available. Both HACE and HAPE are potentially (...) artery pressure which causes interstitial and alveolar pulmonary edema, resulting in impaired oxygenation. Small-vessel hypoxic vasoconstriction is patchy, causing elevated pressure, capillary wall damage, and capillary leakage in less constricted areas. Other factors, such as sympathetic overactivity, may also be involved. Long-time high-altitude residents can develop HAPE when they return after a brief stay at low altitude, a phenomenon referred to as reentry pulmonary edema. Acclimatization

2013 Merck Manual (19th Edition)

130. Frequent subclinical high-altitude pulmonary edema detected by chest sonography as ultrasound lung comets in recreational climbers. (Abstract)

Frequent subclinical high-altitude pulmonary edema detected by chest sonography as ultrasound lung comets in recreational climbers. The ultrasound lung comets detected by chest sonography are a simple, noninvasive, semiquantitative sign of increased extravascular lung water. The aim of this study was to evaluate, by chest sonography, the incidence of interstitial pulmonary edema in recreational high-altitude climbers.Observational study.Eighteen healthy subjects (mean age 45 +/- 10 yrs, ten (...) males) participating in a high-altitude trek in Nepal.Chest and cardiac sonography at sea level and at different altitudes during ascent. Ultrasound lung comets were evaluated on anterior chest at 28 predefined scanning sites.At individual patient analysis, ultrasound lung comets during ascent appeared in 15 of 18 subjects (83%) at 3440 m above sea level and in 18 of 18 subjects (100%) at 4790 m above sea level in the presence of normal left and right ventricular function and pulmonary artery

2010 Critical Care Medicine

131. Altitude sickness

in the tissues of the body). At very high altitude, humans can get either (HAPE), or (HACE). The physiological cause of altitude-induced edema is not conclusively established. It is currently believed, however, that HACE is caused by local vasodilation of cerebral blood vessels in response to , resulting in greater blood flow and, consequently, greater capillary pressures. On the other hand, HAPE may be due to general vasoconstriction in the pulmonary circulation (normally a response to regional ventilation (...) number of people who ascend rapidly to these altitudes. Very high altitude [ ] At very high altitude, 3,500 to 5,500 metres (11,500 to 18,000 ft), maximum SaO 2 falls below 90% as the arterial PO 2 falls below 60mmHg. Extreme may occur during exercise, during sleep, and in the presence of high altitude pulmonary edema or other acute lung conditions. Severe altitude illness occurs most commonly in this range. Extreme altitude [ ] Above 5,500 metres (18,000 ft), marked hypoxemia

2012 Wikipedia

132. Cerebral edema Full Text available with Trip Pro

of this is P.R.E.S., or Posterior Reversible Encephalopathy Syndrome. Altered may cause brain cells to , and dilution of the may cause excess water to move into brain cells. Fast travel to high altitude without proper can cause . Types [ ] Four types of cerebral edema have been identified: Vasogenic [ ] Vasogenic edema occurs due to a breakdown of the that make up the blood–brain barrier. This allows intravascular proteins and fluid to penetrate into the parenchymal extracellular space. Once plasma constituents (...) , , , , and ). Subtypes of vasogenic edema include: Hydrostatic cerebral edema This form of cerebral edema is seen in acute malignant hypertension. It is thought to result from direct transmission of pressure to cerebral with of fluid from the into the . Cerebral edema from brain cancer Cancerous ( ) of the brain can increase secretion of (VEGF), which weakens the junctions of the . can be of benefit in reducing VEGF secretion. High altitude cerebral edema (HACE) is a severe and sometimes fatal form of that results

2012 Wikipedia

133. Pediatric Post–Cardiac Arrest Care: A Scientific Statement From the American Heart Association

patients with out-of-hospital cardiac arrest (OHCA) and those with in-hospital cardiac arrest (IHCA) because witnessed status, preexisting conditions, cause of arrest, and timing and quality of bystander actions, such as immediate administration of high-quality CPR, may differ between OHCA and IHCA. Therefore, we describe the epidemiology of OHCA and IHCA separately. The OHCA literature describes outcomes based on the denominator of all cardiac arrest events that occur in the prehospital setting (...) , extracorporeal cardiopulmonary resuscitation; EEG, electroencephalogram; EMS, emergency medical service; LV, left ventricular; RV, right ventricular; SBP, systolic blood pressure; and SIRS, systemic inflammatory response syndrome. Post–Cardiac Arrest Brain Injury Post–cardiac arrest brain injury remains a leading cause of morbidity and mortality in adults and children because the brain has limited tolerance of ischemia, hyperemia, or edema. The first 3 phases of PCAS involve hypoxemic-hypotensive perfusion

2019 American Heart Association

134. Updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension Full Text available with Trip Pro

; CXR, chest X-ray; ECG, electrocardiogram; FC, functional class; HIV, human immunodeficiency virus; HPAH, heritable pulmonary arterial hypertension; HR, high resolution; IPAH, idiopathic pulmonary arterial hypertension; LFT, liver function test; MRI, magnetic resonance imaging; PCH, pulmonary capillary hemangiomatosis; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; PVOD, pulmonary veno-occlusive disease; VQ, ventilation/perfusion; WHO, World Health Organization. Modified (...) be referred to a lung transplantation center for LuTx evaluation when they remain in an intermediate- or high-risk category despite maximal PAH therapy. In experienced centers, the 1-year survival rates after LuTx now exceed 90%. A pre-transplant rehabilitation program may be considered. Aside from sildenafil and bosentan (>1 year of age), all other agents are considered off-label drugs in children with PH in Europe. Sildenafil dosing recommendations should follow EMA-approved dosing for children

2019 International Society for Heart and Lung Transplantation

135. Evaluation and Management of Testosterone Deficiency

350,000 men) of which were used to support guideline statements. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. Approved by the AUA Board of Directors February 2018 Authors’ disclosure of po- tential conflicts (...) Level: Grade C) Adjunctive Testing 6. In patients with low testosterone, clinicians should measure serum luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) 7. Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/ normal luteinizing hormone levels. (Strong Recommendation; Evidence Level: Grade A) 8. Patients with persistently high prolactin levels of unknown etiology should undergo evaluation for endocrine disorders

2018 American Urological Association

136. CRACKCast E169 – Paediatric Respiratory Emergencies: Lower Airway Obstruction

failure (rales, murmur, gallop, hepatosplenomegaly, cardiomegaly or pulmonary vascular congestion on chest radiograph) Tracheoesophageal fistula (choking, coughing, cyanosis with feeds) Mediastinal mass (chest pain, mediastinal density on chest radiograph) Vascular ring (stridor, cyanosis, apnoea, high-pitched brassy cough, dysphagia) Acquired Foreign body aspiration (history of choking, toddler, asymmetric pulmonary exam, unilateral hyperinflation on chest radiograph) Anaphylaxis (abrupt onset (...) , urticarial rash, angioedema, history of allergies) [2] Outline the pathophysiology of asthma. “Asthma is a lower airway disease marked by bronchoconstriction, mucosal edema, and pulmonary secretions.” – Rosen’s 9 th ed. Often asthma is triggered by a viral URTI [3] What are the features of mild, moderate and severe asthma? mild exacerbation: ● alertness, ● slight tachypnea, ● expiratory wheezing only, ● mildly prolonged expiratory phase, ● minimal accessory muscle use, ● and oxygen saturation of greater

2018 CandiEM

137. Testosterone Therapy in Men with Hypogonadism

with breast or prostate cancer, a palpable prostate nodule or induration, a prostate-specific antigen level > 4 ng/mL, a prostate-specific antigen level > 3 ng/mL combined with a high risk of prostate cancer (without further urological evaluation), elevated hematocrit, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, myocardial infarction or stroke within the last 6 months, or thrombophilia. (1∣⊕⊕OO) 2.3 In hypogonadal men 55 to 69 years old, who (...) . The task force also used consistent language and graphical descriptions of both the strength of a recommendation and the quality of evidence. In terms of the strength of a recommendation, strong recommendations use the phrase “we recommend” and the number 1, and conditional recommendations use the phrase “we suggest” and the number 2. Cross-filled circles indicate the quality of the evidence, such that ⊕OOO denotes very low-quality evidence; ⊕⊕OO, low quality; ⊕⊕⊕O, moderate quality; and ⊕⊕⊕⊕, high

2018 The Endocrine Society

138. CRACKCast E143 – Diving Injuries and Dysbarism

studies: suggesting that the PFO may only open at high ambient pressures Energy: Repetitive dives within several hours of each other Environment: Longer dive (>time) Deeper dive Almost never occurs with dives < 6 meters deep Cold ambient temperature High altitude diving Flying after diving The US Navy has developed dive tables – which are usually programed into dive “computers” – that set limits to prevent DCS. If these limits are exceeded a diver must do “decompression stops underwater” to off-gas (...) marmorata – patchy cyanotic marbling of the skin (trunk and torso) – may first show up as pruritus, then erythema, then mottling. This is due to venous stasis. Lymphatic obstruction presents with edema. Spinal cord at high risk – lumbar region: ● Limb weakness/paralysis ● Paresthesias – distal to proximal migration ● Numbness ● Low back/abdominal pain ● Bladder symptoms, fecal incontinence, priapism ● Patchy symptoms Cerebral symptoms: ● Headache, blurred vision, diplopia, dysarthria, fatigue, behaviour

2018 CandiEM

139. Heart Failure Full Text available with Trip Pro

the risk of cardiovascular events and decrease the risk of developing heart failure. Strong FOR High Angiotensin converting enzyme (ACE) inhibitors should be considered in patients with cardiovascular disease to decrease the risk of cardiovascular events and decrease the risk of developing heart failure. Strong FOR Moderate Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended in patients with type 2 diabetes mellitus associated with cardiovascular disease and insufficient glycaemic control (...) despite metformin, to decrease the risk of cardiovascular events and decrease the risk of hospitalisation for heart failure. Strong FOR High ACE inhibitors are recommended in patients with left ventricular (LV) systolic dysfunction to decrease the risk of developing heart failure. Strong FOR High Beta blockers should be considered in patients with LV systolic dysfunction to decrease the risk of developing heart failure. Strong FOR Low Diagnosis A 12-lead electrocardiogram (ECG) is recommended

2018 Cardiac Society of Australia and New Zealand

140. Atopic Eczema

everyday conditions in most parts of Europe except when 24 air conditioning with pollen filters is used in the indoor environment. In high altitude mountain 25 climate pollen counts are usually lower than in the average living areas. 26 27 Animal epithelia 28 Many patients are aware that contact with animals may lead to a deterioration of skin 29 symptoms. While in former times avoidance of pets was a central feature in primary 30 prevention recommendations for atopy, this has been modified as follows (...) avoidance strategies, especially encasings, 38 can reduce house dust mite and house dust allergen content in indoor air and therefore 39 EDF Guideline AE part I and II final – 24.01.18 (modified 08.05.19) 20 improve AE. The latter is controversial, since a recent meta-analysis would not confirm this 1 effect. (2b) 2 There is evidence that house dust mite avoidance and high altitude climate may give benefit 3 to patients suffering from AE. (2b, 3b) 4 There is a rationale for using protective clothes

2018 European Dermatology Forum

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